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April 20, 2011

New Test Detects Kidney Health

by Sam Savage

(Ivanhoe Newswire) -- According to new research, a biomarker-based diagnostic test is more effective than the current best practice for early detection of adverse outcomes after acute kidney injury (AKI), which can be fatal for an estimated 50 percent of the critically ill patients who get the condition.

A multi-center study reports that a kidney injury biomarker called "neutrophil gelatinase-associated lipocalin" (NGAL) in urine or blood detects early subclinical AKI and its adverse outcomes in critically ill patients. These same patients did not have diagnostic increases in serum creatinine, which is considered the current gold standard for detecting AKI. Early NGAL testing may therefore allow earlier conventional medical interventions or introduction of novel therapies to improve the prognosis of AKI.

Results of the retrospective study -- which included pooled data from 2,322 critically ill adult and pediatric patients -- also justify recommending a reassessment of what defines AKI, according to researchers from 13 international medical organizations collaborating on the study.

The critically ill patients whose data researchers analyzed primarily had Type 1 cardiorenal syndrome, a common condition in which heart dysfunction causes kidney injury. The researchers were surprised to learn that 40 percent of the patients showed unexpected early increases in urine or blood NGAL levels but no increases in serum creatinine.

Even more unexpected was that those patients with early increases in NGAL concentration had a much greater risk of adverse medical outcomes than patients who tested negative for NGAL.

"We concluded that these substantial numbers of patients might reasonably be classified as having sub-clinical AKI, even though they do not fulfill current creatinine-based criteria for AKI," Prasad Devarajan, M.D., director of Nephrology and Hypertension at Cincinnati Children's Hospital Medical Center, and one of the study's first authors, was quoted as saying. "Our findings dictate a need for complete reassessment of the very concept of and diagnosis of AKI. They also point to an urgent need for testing whether NGAL-based early diagnosis of AKI can lead to timelier deployment of therapies and improved outcomes."

SOURCE: Journal of the American College of Cardiology (JACC), published online April 18, 2011